I do not mean a birthday party. Many kids have trouble with them. I just mean with a birthday in general. I've always kept my oldest child's birthdays low key. Really the biggest difference is a cake, a few presents and people wishing her happy birthday. She does fine with attention on any other day. She has even given a sermon at church. But every year on her birthday she has a very hard time. Her anxiety is high and she'll have a tantrum where I have to really intervene to keep everyone and everything safe. This year she turned 17 and for the first time she made the connection about having a hard time on her birthdays. She seems to think it has to do with attention. I'm sure they attention is a big factor, but I also think it is "another transition".

My son used to have more trouble on birthdays when he was younger and I think it was because of all the extra stimulation (sensory issues). As he has grown older these have dissipated, but I could see how anxiety could increase sensitivity on this day.